Why don’t cancer patients enter clinical trials? A review (original) (raw)
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Physician-Related Factors Involved in Patient Decisions to Enroll Onto Cancer Clinical Trials
Journal of Oncology Practice, 2009
Purpose: To examine the attitudes of the public and cancer survivors toward their health-related decisions and cancer clinical trials (CCT) with a particular emphasis on the role of the physician, building on a 2003 report in Journal of Clinical Oncology. Methods: An Internet-based survey was performed in March through April 2005, using a subsample from Knowledge Networks' national probability sample of adults. One sample of 1,027 adults was selected to reflect a cross-section of the public. A second sample of 2,027 cancer survivors was selected from the Knowledge Networks adult panel, representing a probability sample of adult cancer survivors in 2005.
Organizational barriers to physician participation in cancer clinical trials
The American journal of managed care, 2005
To assess barriers to physician participation in cancer clinical trials among oncologists, oncology leaders, and health plan leaders. Mail survey of 221 oncologists combined with semistructured telephone interviews with oncology and plan leaders at 10 integrated healthcare systems. The survey instrument examined physicians' involvement in clinical trials; their perception of the value of trials to them, their patients, and their organization; and the presence of infrastructure support for trials and associated resource constraints. The interviews investigated similar issues from the leaders' perspective. We used linear regression to model trial enrollment and standard qualitative techniques to analyze the interviews. Oncologists estimated they enrolled 7% of patients in trials. They expressed extremely favorable attitudes toward trials as a source of high-quality patient care and a benefit to themselves professionally. While positive attitudes toward trials were common, and ...
Oncologists’ recommendations of clinical trial participation to patients
Patient Education and Counseling, 2008
Objective: To describe the frequency, context and type of oncologists' recommendations to patients that they participate in a clinical trial and to analyze the relationship between recommendations and patients' decisions to participate. Methods: Data included 38 video recorded outpatient interactions during which 15 oncologists invited 38 patients to participate in clinical trials. We described the frequency, context, and type of oncologists' recommendations and analyzed the relationship between these factors and patient decisions to participate and socio-demographic characteristics. Results: Sixty-eight percent (n = 26) of the 38 interactions included an explicit recommendation. Most recommendations were unprompted by patients and/or companions and were tailored to individual patients. A significant relationship was found between recommendations and patients' decisions to participate. Positive trends were found between receiving a recommendation and being female and having higher education. Conclusion: Oncologists routinely make recommendations to patients during the presentation of clinical trials. These recommendations may influence patients' decisions and may occur more frequently with some demographic groups. Practice Implications: Oncologists should be aware of the potential influence of their recommendations when discussing clinical trials with patients. #
Cancer, 2002
BACKGROUNDThe literature continues to report low rates of accrual to cancer clinical trials. Previous studies have examined principally physician-related or patient-related barriers. Clinical research associates (CRAs) have a unique perspective on enrollment that has been explored very little. This study sought the views of CRAs on barriers and facilitators to accrual.The literature continues to report low rates of accrual to cancer clinical trials. Previous studies have examined principally physician-related or patient-related barriers. Clinical research associates (CRAs) have a unique perspective on enrollment that has been explored very little. This study sought the views of CRAs on barriers and facilitators to accrual.METHODSFocus groups were held at six of eight tertiary cancer centers in Ontario, Canada. Audiotapes of sessions were transcribed and subjected to content analysis by two of the authors. Emergent themes were identified. These themes are illustrated by representative quotes taken from the transcripts.Focus groups were held at six of eight tertiary cancer centers in Ontario, Canada. Audiotapes of sessions were transcribed and subjected to content analysis by two of the authors. Emergent themes were identified. These themes are illustrated by representative quotes taken from the transcripts.RESULTSFactors that acted as barriers or facilitators were classified into physician-related, patient-related, or system-related factors. CRAs identified physician attitudes regarding patient participation as the principal physician-related barrier. Barriers, facilitators, and modifying factors that were related to patient involvement were discussed by CRAs. Patients seemed more knowledgeable about trials than in the past and were willing to participate. System factors were considered to have the greatest impact on the ability to accrue. CRAs identified increasing trial and pharmaceutical demands coupled with tight trial time lines. Time was seen as a diminishing resource. Greater demands not only affect specific clinical trial accrual but also affect general support for trials in the cancer center and hospital.Factors that acted as barriers or facilitators were classified into physician-related, patient-related, or system-related factors. CRAs identified physician attitudes regarding patient participation as the principal physician-related barrier. Barriers, facilitators, and modifying factors that were related to patient involvement were discussed by CRAs. Patients seemed more knowledgeable about trials than in the past and were willing to participate. System factors were considered to have the greatest impact on the ability to accrue. CRAs identified increasing trial and pharmaceutical demands coupled with tight trial time lines. Time was seen as a diminishing resource. Greater demands not only affect specific clinical trial accrual but also affect general support for trials in the cancer center and hospital.CONCLUSIONSThe impact of greater demands in a climate of decreasing health care resources is perceived by CRAs as having a negative affect on accrual. Consequently, the important process of translating potentially beneficial basic research findings into clinical practice is slowed. Cancer 2002;95:1577–83. © 2002 American Cancer Society.DOI 10.1002/cncr.10862The impact of greater demands in a climate of decreasing health care resources is perceived by CRAs as having a negative affect on accrual. Consequently, the important process of translating potentially beneficial basic research findings into clinical practice is slowed. Cancer 2002;95:1577–83. © 2002 American Cancer Society.DOI 10.1002/cncr.10862
Attitudes of patients to randomised clinical trials of cancer therapy
European Journal of Cancer, 1998
The aim of this study was to test an instrument which might be useful for doctors in explaining the randomisation procedure to an individual patient. The sample comprised 323 patients with cancer attending for outpatient appointments and/or chemotherapy treatment in two major cancer centres in the U.K. 315 patients completed a self-report questionnaireÐThe Attitudes to Randomised Trials Questionnaire (ARTQ). The results show that the majority of subjects 287 (91.1%) believe that patients should be asked to take part in medical research, but only 242 (76.8%) would be prepared to take part in a study comparing two treatments. If treatment was randomised, only 141 (44.8%) would agree to participate. When given further information about the randomisation procedure, 119 (68.4%) of the 174 (55.2%) who initially said`no' to randomisation or who were unsure, would change their minds and take part in a trial. The ARTQ discriminated between three categories of patient with the following prevailing attitudes: (a) those who seem comfortable with the concept of randomisation; (b) those with some concerns, who with fuller explanation are prepared to consider randomisation; and (c) those ®rmly against randomisation and participation in trials whatever information is provided. Prior knowledge of patients' attitudes might assist communication about trials and encourage more doctors to approach eligible patients.
Clinical Trials, 2020
Background/Aims Essential to bringing innovative cancer treatments to patients is voluntary participation in clinical trials but approximately 8% of American cancer patients are enrolled onto a trial. We used a domain-oriented framework to assess barriers to cancer clinical trial enrollment. Methods Physicians (MD, DO, fellows, residents) and research staff (physician assistants, nurse practitioners, staff and research nurses, clinical assistants, and program coordinators) involved in clinical research at a comprehensive cancer center completed an online survey in 2017; adult cancer patients not currently enrolled in a trial were interviewed in 2018. To inform the construct of our physician/staff and patient surveys and to assess barriers to clinical trial enrollment, we first conducted in-depth interviews among 14 key informants representing medical, hematologic, gynecologic, neurologic, radiation oncology, as well as members of the clinical research team (one clinical research coo...
The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies
American Society of Clinical Oncology Educational Book, 2016
Fewer than one in 20 adult patients with cancer enroll in cancer clinical trials. Although barriers to trial participation have been the subject of frequent study, the rate of trial participation has not changed substantially over time. Barriers to trial participation are structural, clinical, and attitudinal, and they differ according to demographic and socioeconomic factors. In this article, we characterize the nature of cancer clinical trial barriers, and we consider global and local strategies for reducing barriers. We also consider the specific case of adolescents with cancer and show that the low rate of trial enrollment in this age group strongly correlates with limited improvements in cancer population outcomes compared with other age groups. Our analysis suggests that a clinical trial system that enrolls patients at a higher rate produces treatment advances at a faster rate and corresponding improvements in cancer population outcomes. Viewed in this light, the issue of clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor. Fewer barriers to trial participation would enable trials to be completed more quickly and would improve the generalizability of trial results. Moreover, increased accrual to trials is important for patients, because trials provide patients the opportunity to receive the newest treatments. In an era of increasing emphasis on a treatment decision-making process that incorporates the patient perspective, the opportunity for patients to choose trial participation for their care is vital.
Are cancer patients better off if they participate in clinical trials? A mixed methods study
BMC Cancer
Background: Research and cancer care are closely intertwined; however, it is not clear whether physicians and nurses believe that clinical trials offer the best treatment for patients and, if so, whether this belief is justified. The aim of this study was therefore: (i) to explore how physicians and nurses perceive the benefits of clinical trial participation compared with standard care and (ii) whether it is justified to claim that clinical trial participation improves outcomes for cancer patients. Methods: A mixed methods approach was used employing semi-structured interviews with 57 physicians and nurses in oncology and haematology and a literature review of the evidence for trial superiority, i.e. the idea that receiving treatment in a clinical trial leads to a better outcome compared with standard care. Inductive thematic analysis was used to examine the interview data. A literature review comprising nine articles was conducted according to a conceptual framework developed by Peppercorn et al. and evaluated recent evidence on trial superiority. Results: Our findings show that many physicians and nurses make claims supporting trial superiority, however very little evidence is available in the literature comparing outcomes for trial participants and non-participants that supports their assertions.
Factors influencing inclusion of patients with malignancies in clinical trials
Cancer, 2006
Participation in clinical trials remains low and is a central issue in oncology. The authors identified, through a systematic review, 75 papers published up to August 2004 that report barriers to recruitment of patients in clinical trials. These barriers range from patient preference and concern about information/consent to clinical problems with protocols. Strategies to overcome barriers on the part of patients and clinicians are needed and should be carefully evaluated. Thirty-three (44%) papers reported factors related to patients as influencing the inclusion of patients, 28 (37%) reported clinician's related factors, and 37 (49%) other factors from either specific groups of patients (30 papers, 40%) and/or other scopes (13 papers, 17%).